Common Postpartum Issues (Part 3)
Hi, Bestie! Welcome back. Today, I thought we could have another chat on common postpartum issues! As we’ve discussed, the list of issues women face during the postpartum period seems almost endless. We’ve chatted about a bunch of common postpartum issues ranging from shoulder/neck/upper back pain to stress urinary incontinence, and today, we’re going even further as we discuss clogged milk ducts, decreased libido, and more.
First off, let’s define the “Postpartum Period:”
For many, the term “postpartum” refers to the first 6-8 weeks after childbirth. However, the body takes a long time to recover following childbirth–much longer than the typically-assumed 6-8 weeks. The body continues changing and adapting long after delivery, especially when breastfeeding and caring for an entire brand-new human come into play. For our purposes, let’s think of the postpartum period as the first 12 months after childbirth, give or take!
Now let’s dive into some (more) common postpartum issues:
Clogged Milk Ducts/Mastitis: Clogged milk ducts occur when there is a blockage affecting milk flow and they can lead to infection (mastitis) if left untreated. Anyone who has experienced a clogged milk duct can attest they are painful and one of the worst parts of breastfeeding. According to the Mayo Clinic, up to 1 in 5 breastfeeding people will get a clogged milk duct or mastitis (1).
A physical therapist trained and specialized in treatment of clogged milk ducts can help you manage your symptoms and eliminate the blockage. This is often done by using heat and gentle massage. In cases of mastitis where the clog has caused an infection, antibiotics may be needed.
Vaginal Dryness: During the postpartum period, many women notice differences in vaginal lubrication compared with their experiences prior to giving birth. In fact, one study found that 84% of postpartum women reported difficulty in achieving vaginal moisture during sexual intercourse (2). This is due, in large part, to breastfeeding (2). After delivery of a baby, levels of estrogen and progesterone, pregnancy hormones, fall rapidly, while breastfeeding hormones, prolactin and oxytocin, increase (3). This shift in hormone balance is what encourages the breasts to begin milk secretion (3). During breastfeeding, estrogen and progesterone remain low, while the breastfeeding hormones remain high. Why does this matter? This is important because estrogen is a hormone that helps maintain the vagina’s moisture (4). When decreased levels of estrogen are present, it becomes more difficult for the vagina to stay lubricated. Studies show that, while any postpartum mom can experience vaginal dryness, the chance of it doubles if that mom is breastfeeding (5).
Typical levels of vaginal moisture tend to return after a woman discontinues breastfeeding. Some folks breastfeed for years, so this can be a really long period of time to go without adequate moisture. Vaginal moisturizers can be used to add moisture to the vagina. Lubrication is recommended for improving any discomfort related to penetrative vaginal intercourse. Vaginal estrogen is occasionally recommended by specialists, but is not typically prescribed since an increase in estrogen levels can decrease milk production (6).
Decreased Libido: Studies have shown that most women report reduced libido, or desire for sex, during the postpartum period. This decrease in desire often persists far beyond the mandatory 6-week waiting period doctors give to patients after delivering a baby. In fact, studies show that only around 30% of women resumed sex within that initial 6-8 week postpartum period, with most waiting until the three to six month mark (7). Research has suggested that the cause for reduced libido in the postpartum period is multifactorial with roots in physical and emotional exhaustion, hormonal changes, tissue recovery following birth, and more (7).
Fortunately, most women report that their libido did return to its previous levels eventually. For some, this took a few months, for others a year or more, and for others, libido returned after breastfeeding stopped. It’s essential to recognize that everyone’s experiences with postpartum libido will be different. Each individual will have a different reaction to the demands of early parenthood, hormonal fluctuations, the near-constant physical bodily contact that comes with breastfeeding, the lack of sleep new parents face, and so many other factors. If you’re still in the early postpartum period and you feel insecure about your low libido, know that you are not alone and this stage is only temporary.
Rib Flare: During pregnancy, as the fetus and uterus grow, the rest of the abdomen has to shift a bit to make room for everything inside. In the third trimester, the uterus may push up and into the rib cage, causing some of the lower ribs to expand outwards. Toward the end of pregnancy, the ribs expand creating a wider-than-normal rib angle. After delivery, the ribs should return to their pre-pregnancy state, but this is not always the case. If the lower ribs remain in a widened (“flared”) state, this can actually affect the pelvic floor. Because the diaphragm connects to the ribs, the position of the ribs affects the diaphragm’s movement and functionality. Further, the diaphragm and pelvic floor move in relation to each other, so if the diaphragm is moving suboptimally, this can result in pelvic floor issues. Rib flare can be both uncomfortable and a cause for pelvic floor dysfunction.
Your physical therapist can help you improve your rib flare. There are muscles between each of the rib bones and the diaphragm, sitting inside the ribs, is also a muscle! Through specific exercises and breathing techniques, you can reduce the flare of your ribs and return to a more normal rib angle.
If you are struggling with any of the above-mentioned issues, talk with your medical provider about a treatment plan right for you. What other postpartum issues have you experienced? Pro-tip: share this with your non-birthing partner if you’d like them to gain some insight into a few of the physical challenges of postpartum. Let’s chat soon.
XOXO,
Your Pelvic Bestie
References:
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/managing-plugged-ducts-mastitis-when-breastfeeding#:~:text=Plugged%20ducts%20and%20mastitis%20are,term%20breast%20milk%20feeding%20goals.
W Mbarki, H Bettaieb, M Frikha, I Abidi, S Halouani, R Boufarguine, H Oueslati, C Mbarki, Prevalence of and risk factors associated with vaginal lubrication issues in women at 6 months postpartum, The Journal of Sexual Medicine, Volume 19, Issue 5, Supplement 2, 2022, Page S232, ISSN 1743-6095, https://doi.org/10.1016/j.jsxm.2022.03.529.
Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization; 2009. SESSION 2, The physiological basis of breastfeeding. Available from: https://www.ncbi.nlm.nih.gov/books/NBK148970/
Adam, Patricia MD, MSPH; Madlon-Kay, Diane J. MD, MS. What is the prevalence of vaginal dryness postpartum and what is the best treatment?. Evidence-Based Practice 15(12):p 9-10, December 2012.
Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Estradiol. [Updated 2024 May 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501296/
Delgado-Pérez E, Rodríguez-Costa I, Vergara-Pérez F, Blanco-Morales M, Torres-Lacomba M. Recovering Sexuality after Childbirth. What Strategies Do Women Adopt? A Qualitative Study. Int J Environ Res Public Health. 2022 Jan 15;19(2):950. doi: 10.3390/ijerph19020950. PMID: 35055771; PMCID: PMC8775547.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
